Healthcare Provider Details

I. General information

NPI: 1336084649
Provider Name (Legal Business Name): ELEVATE WELLNESS AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 HIGHWAY 33 S STE 9
CLOQUET MN
55720-2665
US

IV. Provider business mailing address

707 HIGHWAY 33 S STE 9
CLOQUET MN
55720-2665
US

V. Phone/Fax

Practice location:
  • Phone: 218-499-0834
  • Fax: 218-878-5788
Mailing address:
  • Phone: 218-499-0834
  • Fax: 218-878-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY K SKYBERG
Title or Position: PRESIDENT
Credential:
Phone: 218-348-6978